Dr. Robert Zarr, president of the Physicians for a National Health Program organization in Washington, D.C., recently spoke to physicians and medical students at Baylor College of Medicine, promoting the idea of a single-payer system of health care in this country.

He sat down with the Houston Chronicle to share his views. Edited excerpts follow.

Q: We are 5½ years into to Affordable Care Act. Has it been a success?

A: It depends a lot on who you are. It depends lot on where you live. It depends a lot on what life was like before the passage of ACA. But in terms of hard numbers we know now, the U.S. Census Bureau has come out with another report and we’re down to 33 million uninsured in 2014, and that’s down from 42 million the year prior. So from that sort of bird’s-eye view, yes, more people have an insurance card in their back pocket. So that’s great.

Q: It feels like there’s a “but” coming.

A: There are tremendous gaps. There are approximately 31 million Americans underinsured and that’s not something we talk a lot about. We’re all happy that we have this increase in insured but what does it fully mean to have insurance? Does it mean you’re going to get the care you need? Does it mean you’re not going to be medically bankrupt? Does it mean you’re going to stop worry about whether you can afford to buy that medicine your doctor prescribed? And in large part, the answer is no.

Underinsurance is better understood by looking at medical bankruptcies. I love to point this out because it is a shocker: If you have about a million bankruptcies claimed every year, about 60 percent of them, 600,000, are medical bankruptcies. They couldn’t pay their bills. What’s even more interesting is that of those 600,000 every year, what percentage had insurance when they got sick? 75 percent.

Q: That’s an amazing statistic. What does that mean for people in this country?

A: What the ACA has done is made underinsurance the new norm. At the end of the day, you and I would like to be assured when we need care, we get it and we don’t spend enormous amounts of our money out of pocket to get it. I think one of the biggest flaws of the ACA is it has relied more on private insurance. The reality is that ACA has bolstered the private insurance industry.

Q: What is the solution?

A: I sometimes say that what needs to happen is we’re going to have to hate the insurance companies more than we fear the government to get to a sensible system. Even if you hate ACA, you very likely believe in entrepreneurship, you believe in free choice, you believe autonomy, and the only way to get to those things is through single payer.

Q: How would single payer work in this country?

A: Single payer is very simple and that’s why I love it. It’s simply a progressive tax system. You generate the funds through a progressive tax and you take that money and put it into a fund and you allow the private delivery of health care. So if you have a solo practice, or you have a family-owned pharmacy, or whatever you are, you keep doing what you are doing — except all of the bureaucracy of these hundreds of insurance companies disappears and you are left with one.

Q: What if you have a catastrophic illness versus someone who has the flu?

A: A runny nose, or a heart attack, a stroke, a dismemberment, it all gets paid for by this national health insurance fund. As a taxpayer, you pay into that. It is the reality for most industrialized countries.

Q: The argument has often been the United States has the best standard of care in the world. Would such wholesale change jeopardize that?

A: The truth is we don’t have the best health outcomes, in part because for every 1 million uninsured, we have 1,000 excess deaths every year. The World Health Organization has ranked us 37th in the world in a number of categories.

Q: But what if you are poor and don’t pay taxes?

A: It’s a progressive tax so if you make zero income you put in zero but you still get services.

Q: Isn’t that where it all falls apart?

A: One day there is a good likelihood you will find yourself in a situation like the person you are talking about. We live in a civilized society. We care for each other. We know that people go through ups and downs in their lives.

Q: As a nation can we afford this?

A: There have been all kinds of cost analyses on single payer, and at the end of the day 95 percent of the population is going to pay what they pay now or less to get a ton more and 5 percent will pay a little bit more.

Q: Still, how do we get from where we are now to there, especially in such a politically divided climate?

A: We’ve been polling Americans for more than 15 years on this issue and every poll I’ve seen says the vast majority of Americans want the establishment of national health insurance. We have polled physicians. People think physicians don’t support this. They do. The public is onboard, the physicians are on board, the unions are onboard. We have a lot of our country that wants this. Part of the problem is we’re used to life as it is. We’re willing on some level to accept it, and we hope it will get better. It’s hard to find the extra energy to see what the future holds for us.